A surgeon at Children's Hospital Colorado reportedly offered to throw in an unexpected treat for a little girl during an outpatient operation: an ear piercing.

But, according to a new story by the investigative journalism organization ProPublica, the real surprise came when the girl's family received the bill. The charge for the ear piercing was listed as $1,877.

"There are a lot of things we'd pay extra for a doctor to do," Margaret O'Neill, the 5-year-old girl's mother, told ProPublica for its article, published this week. "This is not one of them."

ProPublica used the procedure, which it said occurred two years ago, to highlight the problem of overutilization in medical care — patients receiving extra procedures that they don't need and maybe don't even want but that come at a great cost both to them and to insurers. The U.S. health care system wastes an estimated $210 billion per year on unnecessary or overly-expensive care, according to a 2012 National Academy of Medicine report that ProPublica cited in its article.

But a spokeswoman for Children's disputes that the hospital upcharges patients for pricey ear piercings and other cosmetic procedures.

Elizabeth Whitehead, the spokeswoman, said she could not talk about the specifics of the procedure or the bill ProPublica reported on because of patient privacy laws.

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But she said, generally, the hospital includes charges on its bills for operating room time. The hospital charges the first 10 minutes of a procedure at a flat fee and then assesses a per-minute charge after that.

When it puts a patient's itemized bill together, Whitehead said, Children's averages the total operating room charges across all the procedures performed on a patient and applies an equal charge to each. That practice complies with billing guidelines laid out by the federal Centers for Medicare and Medicaid Services, she said.

"It is incredibly difficult to assign minutes for procedures, therefore we follow the CMS guidance and equally split the minutes among all procedures," Whitehead wrote in an email.

That means the itemized amount that shows up on a bill for a specific procedure, such as an ear piercing, might not reflect what the procedure actually cost or the length of time the procedure took. The real cost for that procedure on its own could be higher or lower. In the end, the total on the bill reflects the charge for the hospital's combined services.

Whitehead said Children's records indicate surgeons have performed three ear piercings in the hospital's operating rooms in the past five years. Two of those, she said, occurred following ear reconstruction surgeries.

"Ear piercing in the operating room is extremely rare and done only upon the request of the family," Whitehead wrote in another email.

"We are happy to proactively work with families to help them understand what their health insurance covers and their potential responsibility," she added.

O'Neill, the 5-year-old girl's mother, could not be reached for comment.

Children's explanation of its billing practices suggests that, had the ear piercing not taken place, the overall charge for the surgery would not have been $1,877 lower. But Children's billing practices may have shifted surgical costs that would otherwise have been covered by insurance onto O'Neill.

O'Neill told ProPublica that her daughter, who was not named in the article, had a condition where the thin flap of tissue that connected her tongue to the bottom of her mouth was too tight. The surgery at Children's was intended to cut the tissue to free up her tongue. The surgeon offered the ear piercing as a bonus.

When the bill arrived, though, O'Neill told ProPublica that her insurance company objected to paying for the ear piercing, leaving her to pay the full itemized amount listed for that procedure. O'Neill told ProPublica that she disputed the charge with Children's, and the hospital ultimately threatened to send the bill to collections. Earlier this year, after ProPublica inquired about the bill, the hospital canceled the remaining balance, according to the news outlet.

Ear piercings are most commonly done outside of hospitals. The familiar mall brand Claire's offers to pierce ears for free with the purchase of an $18.99 "starter kit" that includes a pair of earrings.

Whitehead declined to say whether the incident has so far resulted in specific policy changes to how Children's bills patients or what type of elective procedures the hospital offers to patients. She said Children's is reviewing the matter.

"We welcome the opportunity this brings to our ongoing discussions about processes and improving upon the patient-family experience," she wrote in an email.

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